A47550 Bone Mass Measurements Description ICD 9 Codes CPT/HCPCS Codes Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. The following CPT codes are used to describe the type of bone density measurement tests that are currently available and covered. 76977 ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY METHOD 77078 COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE) 77079 COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1 OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL) 77080 DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE) 77081 DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL) 77083 G0130 RADIOGRAPHIC ABSORPTIOMETRY (EG, PHOTODENSITOMETRY, RADIOGRAMMETRY), 1 OR MORE SITES SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL) ICD-9 Codes that Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Patients who qualify by statute for osteoporosis screening may be evaluated by studies that are characterized by CPT codes 77078 , 77079 , 77080 , 77081 , 77083 , 76977 , and G0130. The following is a list of ICD-9-CM codes that support the medical necessity of osteoporosis screening. 241.0 NONTOXIC UNINODULAR GOITER 246.9 UNSPECIFIED DISORDER OF THYROID 252.00 - 252.08 HYPERPARATHYROIDISM, UNSPECIFIED - OTHER HYPERPARATHYROIDISM 255.0 CUSHING'S SYNDROME 256.2 POSTABLATIVE OVARIAN FAILURE 256.31 PREMATURE MENOPAUSE 256.39 OTHER OVARIAN FAILURE 259.3 ECTOPIC HORMONE SECRETION NOT ELSEWHERE CLASSIFIED 627.2 SYMPTOMATIC MENOPAUSAL OR FEMALE CLIMACTERIC STATES 627.4 SYMPTOMATIC STATES ASSOCIATED WITH ARTIFICIAL MENOPAUSE 733.00 OSTEOPOROSIS UNSPECIFIED 733.01 SENILE OSTEOPOROSIS 733.02 IDIOPATHIC OSTEOPOROSIS 733.03 DISUSE OSTEOPOROSIS 733.09 OTHER OSTEOPOROSIS 733.11 - 733.16 PATHOLOGICAL FRACTURE OF HUMERUS - PATHOLOGICAL FRACTURE OF TIBIA OR FIBULA 733.19 PATHOLOGICAL FRACTURE OF OTHER SPECIFIED SITE 733.90 DISORDER OF BONE AND CARTILAGE UNSPECIFIED 733.93 STRESS FRACTURE OF TIBIA OR FIBULA 733.94 STRESS FRACTURE OF THE METATARSALS 733.95 STRESS FRACTURE OF OTHER BONE 733.96 STRESS FRACTURE OF FEMORAL NECK 733.97 STRESS FRACTURE OF SHAFT OF FEMUR 733.98 STRESS FRACTURE OF PELVIS 781.91 LOSS OF HEIGHT V49.81 ASYMPTOMATIC POSTMENOPAUSAL STATUS (AGE-RELATED) (NATURAL) V58.65 LONG-TERM (CURRENT) USE OF STEROIDS A47550 Bone Mass Measurements Description ICD 9 Codes Once the diagnosis of osteoporosis has been established, the effectiveness of treatment can ONLY be monitored using a dual energy x-ray absorptiometry (CPT code 77080 ). The valid ICD-9-CM codes for the established diagnosis of osteoporosis are: 255.0 CUSHING'S SYNDROME 733.00 OSTEOPOROSIS UNSPECIFIED 733.01 SENILE OSTEOPOROSIS 733.02 IDIOPATHIC OSTEOPOROSIS 733.03 DISUSE OSTEOPOROSIS 733.09 OTHER OSTEOPOROSIS 733.90 DISORDER OF BONE AND CARTILAGE UNSPECIFIED ICD-9 Codes that DO NOT Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Peripheral scans are characterized by CPT codes 77078 , 77079 , 77081 , 77083 , 76977 , G0130. These scans are NOT covered for the monitoring of the effectiveness of osteoporosis therapy. Therefore, if any of the following codes are the only codes submitted on the claim, the claim will NOT be covered 255.0 CUSHING'S SYNDROME 733.00 OSTEOPOROSIS UNSPECIFIED 733.01 SENILE OSTEOPOROSIS 733.02 IDIOPATHIC OSTEOPOROSIS 733.03 DISUSE OSTEOPOROSIS 733.09 OTHER OSTEOPOROSIS 733.90 DISORDER OF BONE AND CARTILAGE UNSPECIFIED ICD 9 Codes Non-Invasive Cerebrovascular Arterial Studies L27504 Description 93875 NONINVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, COMPLETE BILATERAL STUDY (EG, PERIORBITAL FLOW DIRECTION WITH ARTERIAL COMPRESSION, OCULAR PNEUMOPLETHYSMOGRAPHY, DOPPLER ULTRASOUND SPECTRAL ANALYSIS) 93880 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY 93882 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY 93886 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY 93888 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY 93890 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; VASOREACTIVITY STUDY 93892 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITHOUT INTRAVENOUS MICROBUBBLE INJECTION TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITH INTRAVENOUS MICROBUBBLE INJECTION 93893 ICD-9 Codes that Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Please see revision history for ICD-9-CM code updates effective 10/01/2009. 237.3 342.00 - 342.92 344.00 - 344.9 346.01 346.20 - 346.21 346.80 - 346.81 For CPT codes 93875, 93880, and 93882: NEOPLASM OF UNCERTAIN BEHAVIOR OF PARAGANGLIA FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE QUADRIPLEGIA UNSPECIFIED - PARALYSIS UNSPECIFIED MIGRAINE WITH AURA, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - VARIANTS OF MIGRAINE, NOT ELSEWHERE CLASSIFIED, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS OTHER FORMS OF MIGRAINE, WITHOUT MENTION OF INTRACTABLE MIGRAINE WITHOUT MENTION OF STATUS MIGRAINOSUS - OTHER FORMS OF MIGRAINE, WITH INTRACTABLE MIGRAINE, SO STATED, WITHOUT MENTION OF STATUS MIGRAINOSUS 348.81 TEMPORAL SCLEROSIS 348.89* OTHER CONDITIONS OF BRAIN 362.30 - 362.37 RETINAL VASCULAR OCCLUSION UNSPECIFIED - VENOUS ENGORGEMENT OF RETINA 362.84 RETINAL ISCHEMIA 364.42 RUBEOSIS IRIDIS 368.10 - 368.12 SUBJECTIVE VISUAL DISTURBANCE UNSPECIFIED - TRANSIENT VISUAL LOSS 368.2 DIPLOPIA 368.40 - 368.47 VISUAL FIELD DEFECT UNSPECIFIED - HETERONYMOUS BILATERAL FIELD DEFECTS 431 INTRACEREBRAL HEMORRHAGE 433.00 - 433.91 OCCLUSION AND STENOSIS OF BASILAR ARTERY WITHOUT CEREBRAL INFARCTION - OCCLUSION AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY WITH CEREBRAL INFARCTION 434.00 - 434.91 435.0 - 435.9 CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITH CEREBRAL INFARCTION BASILAR ARTERY SYNDROME - UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA 436 ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE 437.0 - 437.1 CEREBRAL ATHEROSCLEROSIS - OTHER GENERALIZED ISCHEMIC CEREBROVASCULAR DISEASE 437.3 - 437.5 CEREBRAL ANEURYSM NONRUPTURED - MOYAMOYA DISEASE 437.7 TRANSIENT GLOBAL AMNESIA 437.9 UNSPECIFIED CEREBROVASCULAR DISEASE 442.81 - 442.82 ANEURYSM OF ARTERY OF NECK - ANEURYSM OF SUBCLAVIAN ARTERY 443.21 DISSECTION OF CAROTID ARTERY 444.9* EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY 446.0 - 446.7 POLYARTERITIS NODOSA - TAKAYASU'S DISEASE ICD 9 Codes Non-Invasive Cerebrovascular Arterial Studies L27504 Description 447.0 - 447.2 ARTERIOVENOUS FISTULA ACQUIRED - RUPTURE OF ARTERY 447.6 ARTERITIS UNSPECIFIED 447.8 - 447.9 449 OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES - UNSPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES SEPTIC ARTERIAL EMBOLISM 780.2* SYNCOPE AND COLLAPSE 781.2 - 781.4 ABNORMALITY OF GAIT - TRANSIENT PARALYSIS OF LIMB 781.94 FACIAL WEAKNESS 782.0 DISTURBANCE OF SKIN SENSATION 784.2* SWELLING MASS OR LUMP IN HEAD AND NECK 784.3 APHASIA 784.51 DYSARTHRIA 784.59 OTHER SPEECH DISTURBANCE 785.9* OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM 787.20 - 787.29 DYSPHAGIA, UNSPECIFIED - OTHER DYSPHAGIA 900.00 - 900.9 901.1 INJURY TO CAROTID ARTERY UNSPECIFIED - INJURY TO UNSPECIFIED BLOOD VESSEL OF HEAD AND NECK INJURY TO INNOMINATE AND SUBCLAVIAN ARTERIES 958.4 TRAUMATIC SHOCK 996.1 MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT 996.70 - 996.79 OTHER COMPLICATIONS DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT - OTHER COMPLICATIONS DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT 998.0 - 998.9 V43.4 POSTOPERATIVE SHOCK NOT ELSEWHERE CLASSIFIED - UNSPECIFIED COMPLICATION OF PROCEDURE NOT ELSEWHERE CLASSIFIED BLOOD VESSEL REPLACED BY OTHER MEANS V45.89 OTHER POSTSURGICAL STATUS V58.49 OTHER SPECIFIED AFTERCARE FOLLOWING SURGERY V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY *Note: Use code 348.89 to identify assessment of Suspected Brain Death; use code 444.9 to report Paradoxical Cerebral Embolism; use code 780.2 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency; use code 784.2 to report Pulsatile Neck Mass; use code 785.9 to report Carotid Bruit. 282.60 - 282.69 For CPT codes 93886, 93888, 93890, 93892, and 93893: SICKLE-CELL DISEASE UNSPECIFIED - OTHER SICKLE-CELL DISEASE WITH CRISIS 348.81 TEMPORAL SCLEROSIS 348.89* OTHER CONDITIONS OF BRAIN 362.30 - 362.37 RETINAL VASCULAR OCCLUSION UNSPECIFIED - VENOUS ENGORGEMENT OF RETINA 362.84 RETINAL ISCHEMIA 364.42 RUBEOSIS IRIDIS 368.10 - 368.12 SUBJECTIVE VISUAL DISTURBANCE UNSPECIFIED - TRANSIENT VISUAL LOSS 368.2 DIPLOPIA 368.40 - 368.47 VISUAL FIELD DEFECT UNSPECIFIED - HETERONYMOUS BILATERAL FIELD DEFECTS 430 SUBARACHNOID HEMORRHAGE 431 INTRACEREBRAL HEMORRHAGE 433.00 - 433.21 435.0 - 435.9 OCCLUSION AND STENOSIS OF BASILAR ARTERY WITHOUT CEREBRAL INFARCTION - OCCLUSION AND STENOSIS OF VERTEBRAL ARTERY WITH CEREBRAL INFARCTION OCCLUSION AND STENOSIS OF OTHER SPECIFIED PRECEREBRAL ARTERY WITHOUT CEREBRAL INFARCTION - OCCLUSION AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY WITH CEREBRAL INFARCTION CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION - CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITH CEREBRAL INFARCTION BASILAR ARTERY SYNDROME - UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA 436 ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE 437.0 - 437.1 CEREBRAL ATHEROSCLEROSIS - OTHER GENERALIZED ISCHEMIC CEREBROVASCULAR DISEASE 437.3 - 437.5 CEREBRAL ANEURYSM NONRUPTURED - MOYAMOYA DISEASE 433.80 - 433.91 434.00 - 434.91 ICD 9 Codes Non-Invasive Cerebrovascular Arterial Studies L27504 Description 437.7 TRANSIENT GLOBAL AMNESIA 437.9 UNSPECIFIED CEREBROVASCULAR DISEASE 442.81 - 442.82 ANEURYSM OF ARTERY OF NECK - ANEURYSM OF SUBCLAVIAN ARTERY 444.9* EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY 446.0 - 446.29 POLYARTERITIS NODOSA - OTHER SPECIFIED HYPERSENSITIVITY ANGIITIS 447.0 - 447.2 ARTERIOVENOUS FISTULA ACQUIRED - RUPTURE OF ARTERY 447.6 ARTERITIS UNSPECIFIED 447.8 - 447.9 449 OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES - UNSPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES SEPTIC ARTERIAL EMBOLISM 747.81 CONGENITAL ANOMALIES OF CEREBROVASCULAR SYSTEM 780.2* SYNCOPE AND COLLAPSE 781.2 - 781.5 ABNORMALITY OF GAIT - CLUBBING OF FINGERS 781.94 FACIAL WEAKNESS 782.0 DISTURBANCE OF SKIN SENSATION 784.3 APHASIA 784.51 DYSARTHRIA 784.59 OTHER SPEECH DISTURBANCE 785.9* OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM 787.20 - 787.29 DYSPHAGIA, UNSPECIFIED - OTHER DYSPHAGIA 900.00 - 900.9 901.1 INJURY TO CAROTID ARTERY UNSPECIFIED - INJURY TO UNSPECIFIED BLOOD VESSEL OF HEAD AND NECK INJURY TO INNOMINATE AND SUBCLAVIAN ARTERIES 958.4 TRAUMATIC SHOCK 996.1 MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT 996.74 OTHER COMPLICATIONS DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT 998.11 - 998.4 HEMORRHAGE COMPLICATING A PROCEDURE - FOREIGN BODY ACCIDENTALLY LEFT DURING A PROCEDURE NOT ELSEWHERE CLASSIFIED PERSISTENT POSTOPERATIVE FISTULA NOT ELSEWHERE CLASSIFIED - ACUTE REACTION TO FOREIGN SUBSTANCE ACCIDENTALLY LEFT DURING A PROCEDURE NOT ELSEWHERE CLASSIFIED 998.6 - 998.7 V43.4 BLOOD VESSEL REPLACED BY OTHER MEANS V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY *Note: Use code 348.89 to identify assessment of Suspected Brain Death; use code 444.9 to report Paradoxical Cerebral Embolism; use code 780.2 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency; use code 785.9 to report Carotid Bruit. L-27506 Non-Invasive Peripheral Venous Studies Description ICD 9 Codes CPT/HCPCS Codes Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. 93965 NONINVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (EG, DOPPLER WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER MANEUVERS, PHLEBORHEOGRAPHY, IMPEDANCE PLETHYSMOGRAPHY) 93970 93971 G0365 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY VESSEL MAPPING OF VESSELS FOR HEMODIALYSIS ACCESS (SERVICES FOR PREOPERATIVE VESSEL MAPPING PRIOR TO CREATION OF HEMODIALYSIS ACCESS USING AN AUTOGENOUS HEMODIALYSIS CONDUIT, INCLUDING ARTERIAL INFLOW AND VENOUS OUTFLOW) ICD-9 Codes that Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. 415.11 - 415.19 IATROGENIC PULMONARY EMBOLISM AND INFARCTION - OTHER PULMONARY EMBOLISM AND INFARCTION 444.9* EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY 451.0 - 451.9 452 453.1 - 453.2 453.40 - 453.74 453.79 - 453.84 453.89 - 453.9 454.0 - 454.8 459.10 - 459.39 585.4 - 585.6* 671.00 - 671.94 PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITIES PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE PORTAL VEIN THROMBOSIS THROMBOPHLEBITIS MIGRANS - OTHER VENOUS EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY - CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS - ACUTE VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS - EMBOLISM AND THROMBOSIS OF UNSPECIFIED SITE VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER - VARICOSE VEINS OF LOWER EXTREMITIES WITH OTHER COMPLICATIONS POSTPHLEBETIC SYNDROME WITHOUT COMPLICATIONS - CHRONIC VENOUS HYPERTENSION WITH OTHER COMPLICATION CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE) - END STAGE RENAL DISEASE 695.9 VARICOSE VEINS OF LEGS COMPLICATING PREGNANCY AND THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE - UNSPECIFIED POSTPARTUM VENOUS COMPLICATION OBSTETRICAL BLOOD-CLOT EMBOLISM UNSPECIFIED AS TO EPISODE OF CARE OBSTETRICAL BLOOD-CLOT EMBOLISM POSTPARTUM UNSPECIFIED ERYTHEMATOUS CONDITION 707.10 - 707.19 UNSPECIFIED ULCER OF LOWER LIMB - ULCER OF OTHER PART OF LOWER LIMB 729.5 PAIN IN LIMB 729.81 SWELLING OF LIMB 747.60 - 747.69 782.2 - 782.3 ANOMALY OF THE PERIPHERAL VASCULAR SYSTEM UNSPECIFIED SITE - ANOMALIES OF OTHER SPECIFIED SITES OF PERIPHERAL VASCULAR SYSTEM LOCALIZED SUPERFICIAL SWELLING MASS OR LUMP - EDEMA 785.4 GANGRENE 786.00 RESPIRATORY ABNORMALITY UNSPECIFIED 786.03 APNEA 786.05 SHORTNESS OF BREATH 786.06 TACHYPNEA 673.20 - 673.24 786.09 RESPIRATORY ABNORMALITY OTHER 786.3 HEMOPTYSIS 786.50 UNSPECIFIED CHEST PAIN 786.52 PAINFUL RESPIRATION L-27506 Non-Invasive Peripheral Venous Studies Description ICD 9 Codes 786.59 OTHER CHEST PAIN 794.2 NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF PULMONARY SYSTEM 903.00 - 903.9 INJURY TO AXILLARY VESSEL(S) UNSPECIFIED - INJURY TO UNSPECIFIED BLOOD VESSEL OF UPPER EXTREMITY INJURY TO COMMON FEMORAL ARTERY - INJURY TO BLOOD VESSELS OF UNSPECIFIED SITE MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT 904.0 - 904.9 996.1 996.70 - 996.79 OTHER COMPLICATIONS DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT - OTHER COMPLICATIONS DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT 997.2 PERIPHERAL VASCULAR COMPLICATIONS NOT ELSEWHERE CLASSIFIED 997.79 VASCULAR COMPLICATIONS OF OTHER VESSELS 998.2 ACCIDENTAL PUNCTURE OR LACERATION DURING A PROCEDURE NOT ELSEWHERE CLASSIFIED OTHER VASCULAR COMPLICATIONS OF MEDICAL CARE NOT ELSEWHERE CLASSIFIED 999.2 V12.51 - V12.52 V42.0 PERSONAL HISTORY OF VENOUS THROMBOSIS AND EMBOLISM - PERSONAL HISTORY OF THROMBOPHLEBITIS KIDNEY REPLACED BY TRANSPLANT V45.81 POSTSURGICAL AORTOCORONARY BYPASS STATUS V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY V72.83* OTHER SPECIFIED PRE-OPERATIVE EXAMINATION *NOTE: Use code 444.9 for paradoxical embolism; use codes 585.4, 585.5 or 585.6 (secondary diagnosis) with code V72.83 for G0365; code V72.83 is covered only for CPT/HCPCS codes 93971 and G0365. LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes CPT/HCPCS Codes Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. Hospitals should use guidelines and descriptors associated with the applicable Level I CPT code(s) to bill for echocardiograms without contrast. 93303 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE 93304 93306 93307 93308 93320 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY A9700 DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); COMPLETE DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); FOLLOWUP OR LIMITED STUDY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING) DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHY) SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY Q9955 INJECTION, PERFLEXANE LIPID MICROSPHERES, PER ML Q9956 INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML 93321 93325 Q9957 INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML Hospitals billing under OPPS are instructed to bill for echocardiograms with contrast or without contrast, followed by contrast studies using the applicable HCPCS code(s) below. They should also report the appropriate units of HCPCS codes for the contrast agents used in the performance of the echocardiograms. Please see revision history for code description update retroactive to 01/01/2010. C8921 TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE C8922 TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY C8923 TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY C8924 TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY C8929 ICD-9 Codes that Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. 032.82 DIPHTHERITIC MYOCARDITIS 074.21 COXSACKIE PERICARDITIS 074.22 COXSACKIE ENDOCARDITIS 074.23 COXSACKIE MYOCARDITIS 086.0 CHAGAS' DISEASE WITH HEART INVOLVEMENT LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes 088.81 LYME DISEASE 093.0 ANEURYSM OF AORTA SPECIFIED AS SYPHILITIC 093.1 SYPHILITIC AORTITIS 093.21 SYPHILITIC ENDOCARDITIS OF MITRAL VALVE 093.22 SYPHILITIC ENDOCARDITIS OF AORTIC VALVE 093.23 SYPHILITIC ENDOCARDITIS OF TRICUSPID VALVE 093.24 SYPHILITIC ENDOCARDITIS OF PULMONARY VALVE 093.81 SYPHILITIC PERICARDITIS 093.82 SYPHILITIC MYOCARDITIS 098.83 GONOCOCCAL PERICARDITIS 098.84 GONOCOCCAL ENDOCARDITIS 112.81 CANDIDAL ENDOCARDITIS 115.03 HISTOPLASMA CAPSULATUM PERICARDITIS 115.04 HISTOPLASMA CAPSULATUM ENDOCARDITIS 115.13 HISTOPLASMA DUBOISII PERICARDITIS 115.14 HISTOPLASMA DUBOISII ENDOCARDITIS 130.3 MYOCARDITIS DUE TO TOXOPLASMOSIS 135 SARCOIDOSIS 164.1 MALIGNANT NEOPLASM OF HEART 198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES 212.7 BENIGN NEOPLASM OF HEART 238.8 NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER SPECIFIED SITES 239.81 NEOPLASMS OF UNSPECIFIED NATURE, RETINA AND CHOROID 239.89 NEOPLASMS OF UNSPECIFIED NATURE, OTHER SPECIFIED SITES 275.0 DISORDERS OF IRON METABOLISM 276.50 - 276.52 VOLUME DEPLETION, UNSPECIFIED - HYPOVOLEMIA 277.30 AMYLOIDOSIS, UNSPECIFIED 277.31 FAMILIAL MEDITERRANEAN FEVER 277.39 OTHER AMYLOIDOSIS 391.0 ACUTE RHEUMATIC PERICARDITIS 391.1 ACUTE RHEUMATIC ENDOCARDITIS 391.2 ACUTE RHEUMATIC MYOCARDITIS 391.8 OTHER ACUTE RHEUMATIC HEART DISEASE 391.9 ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED 392.0 RHEUMATIC CHOREA WITH HEART INVOLVEMENT 393 CHRONIC RHEUMATIC PERICARDITIS 394.0 - 394.2 MITRAL STENOSIS - MITRAL STENOSIS WITH INSUFFICIENCY 394.9 OTHER AND UNSPECIFIED MITRAL VALVE DISEASES 395.0 RHEUMATIC AORTIC STENOSIS 395.1 RHEUMATIC AORTIC INSUFFICIENCY 395.2 RHEUMATIC AORTIC STENOSIS WITH INSUFFICIENCY 396.0 - 396.3 397.0 - 397.1 MITRAL VALVE STENOSIS AND AORTIC VALVE STENOSIS - MITRAL VALVE INSUFFICIENCY AND AORTIC VALVE INSUFFICIENCY MULTIPLE INVOLVEMENT OF MITRAL AND AORTIC VALVES - MITRAL AND AORTIC VALVE DISEASES UNSPECIFIED DISEASES OF TRICUSPID VALVE - RHEUMATIC DISEASES OF PULMONARY VALVE 397.9 RHEUMATIC DISEASES OF ENDOCARDIUM VALVE UNSPECIFIED 398.0 RHEUMATIC MYOCARDITIS 398.91 RHEUMATIC HEART FAILURE (CONGESTIVE) 396.8 - 396.9 398.99 OTHER RHEUMATIC HEART DISEASES 401.0 MALIGNANT ESSENTIAL HYPERTENSION 402.00 MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE 402.10 BENIGN HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE 402.90 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes 404.00 - 404.03 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED - HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE 404.10 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED 404.90 - 404.93 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE 405.11 BENIGN RENOVASCULAR HYPERTENSION 405.19 OTHER BENIGN SECONDARY HYPERTENSION 410.00 - 410.02 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE 410.10 - 410.12 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE 410.20 - 410.22 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE 410.30 - 410.32 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE 410.40 - 410.42 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE 410.50 - 410.52 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE 410.60 - 410.62 TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED - TRUE POSTERIOR WALL INFARCTION SUBSEQUENT EPISODE OF CARE SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED - SUBENDOCARDIAL INFARCTION SUBSEQUENT EPISODE OF CARE ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE 410.70 - 410.72 410.80 - 410.82 411.0 - 411.1 POSTMYOCARDIAL INFARCTION SYNDROME - INTERMEDIATE CORONARY SYNDROME 411.81 ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION 411.89 OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER 412 OLD MYOCARDIAL INFARCTION 413.0 - 413.1 ANGINA DECUBITUS - PRINZMETAL ANGINA 413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS 414.00 - 414.07 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT - CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART 414.10 - 414.12 ANEURYSM OF HEART (WALL) - DISSECTION OF CORONARY ARTERY 414.19 OTHER ANEURYSM OF HEART 414.2 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY 414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE 415.0 ACUTE COR PULMONALE 415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION 416.0 PRIMARY PULMONARY HYPERTENSION 416.2 CHRONIC PULMONARY EMBOLISM 416.8 OTHER CHRONIC PULMONARY HEART DISEASES 416.9 CHRONIC PULMONARY HEART DISEASE UNSPECIFIED 420.0 ACUTE PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE 420.90 - 420.91 ACUTE PERICARDITIS UNSPECIFIED - ACUTE IDIOPATHIC PERICARDITIS 420.99 OTHER ACUTE PERICARDITIS LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes 421.0 - 421.1 421.9 ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS - ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE ACUTE ENDOCARDITIS UNSPECIFIED 422.0 ACUTE MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE 422.91 IDIOPATHIC MYOCARDITIS 422.92 SEPTIC MYOCARDITIS 422.93 TOXIC MYOCARDITIS 423.0 - 423.2 HEMOPERICARDIUM - CONSTRICTIVE PERICARDITIS 423.8 - 423.9 OTHER SPECIFIED DISEASES OF PERICARDIUM - UNSPECIFIED DISEASE OF PERICARDIUM 424.0 - 424.3 MITRAL VALVE DISORDERS - PULMONARY VALVE DISORDERS 424.90 - 424.99 425.0 - 425.9 ENDOCARDITIS VALVE UNSPECIFIED UNSPECIFIED CAUSE - OTHER ENDOCARDITIS VALVE UNSPECIFIED ENDOMYOCARDIAL FIBROSIS - SECONDARY CARDIOMYOPATHY UNSPECIFIED 426.0 ATRIOVENTRICULAR BLOCK COMPLETE 426.12 MOBITZ (TYPE) II ATRIOVENTRICULAR BLOCK 426.3 OTHER LEFT BUNDLE BRANCH BLOCK 426.50 - 426.54 BUNDLE BRANCH BLOCK UNSPECIFIED - TRIFASCICULAR BLOCK 426.6 OTHER HEART BLOCK 426.7 ANOMALOUS ATRIOVENTRICULAR EXCITATION 426.9 CONDUCTION DISORDER UNSPECIFIED 427.0 PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA 427.1 PAROXYSMAL VENTRICULAR TACHYCARDIA 427.31 ATRIAL FIBRILLATION 427.32 ATRIAL FLUTTER 427.41 VENTRICULAR FIBRILLATION 427.42 VENTRICULAR FLUTTER 427.5 CARDIAC ARREST 427.60 - 427.61 PREMATURE BEATS UNSPECIFIED - SUPRAVENTRICULAR PREMATURE BEATS 427.69 OTHER PREMATURE BEATS 427.81 SINOATRIAL NODE DYSFUNCTION 427.89 OTHER SPECIFIED CARDIAC DYSRHYTHMIAS 428.0 CONGESTIVE HEART FAILURE UNSPECIFIED 428.1 LEFT HEART FAILURE 428.20 - 428.23 UNSPECIFIED SYSTOLIC HEART FAILURE - ACUTE ON CHRONIC SYSTOLIC HEART FAILURE 428.30 - 428.33 UNSPECIFIED DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC DIASTOLIC HEART FAILURE 428.40 - 428.43 429.0 UNSPECIFIED COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE - ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE MYOCARDITIS UNSPECIFIED 429.1 MYOCARDIAL DEGENERATION 429.2 CARDIOVASCULAR DISEASE UNSPECIFIED 429.3 CARDIOMEGALY 429.4 FUNCTIONAL DISTURBANCES FOLLOWING CARDIAC SURGERY 429.5 RUPTURE OF CHORDAE TENDINEAE 429.6 RUPTURE OF PAPILLARY MUSCLE 429.71 429.79 CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED ACQUIRED CARDIAC SEPTAL DEFECT CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED OTHER 429.81 OTHER DISORDERS OF PAPILLARY MUSCLE 434.10 - 434.11 435.0 CEREBRAL EMBOLISM WITHOUT CEREBRAL INFARCTION - CEREBRAL EMBOLISM WITH CEREBRAL INFARCTION BASILAR ARTERY SYNDROME 435.8 OTHER SPECIFIED TRANSIENT CEREBRAL ISCHEMIAS 435.9 UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIA 436 ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE 440.20 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES UNSPECIFIED LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes 440.4 CHRONIC TOTAL OCCLUSION OF ARTERY OF THE EXTREMITIES 441.00 DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE 441.01 DISSECTION OF AORTA THORACIC 441.03 DISSECTION OF AORTA THORACOABDOMINAL 441.1 THORACIC ANEURYSM RUPTURED 441.2 THORACIC ANEURYSM WITHOUT RUPTURE 441.6 THORACOABDOMINAL ANEURYSM RUPTURED 441.7 THORACOABDOMINAL ANEURYSM WITHOUT RUPTURE 441.9 AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE 444.21 - 444.22 ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY - ARTERIAL EMBOLISM AND THROMBOSIS OF LOWER EXTREMITY ACUTE FEBRILE MUCOCUTANEOUS LYMPH NODE SYNDROME (MCLS) 446.1 446.7 TAKAYASU'S DISEASE 449 SEPTIC ARTERIAL EMBOLISM 458.0 ORTHOSTATIC HYPOTENSION 518.4 ACUTE EDEMA OF LUNG UNSPECIFIED 518.5 PULMONARY INSUFFICIENCY FOLLOWING TRAUMA AND SURGERY 518.7 TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) 518.82 OTHER PULMONARY INSUFFICIENCY NOT ELSEWHERE CLASSIFIED 674.50 - 674.54 PERIPART CARDIOMYOPATHY UNSPECIFIED - PERIPARTUM CARDIOMYOPATHY WITH POSTPARTUM CONDITION OR COMPLICATION OTHER COMPLICATIONS OF PUERPERIUM WITH DELIVERY WITH POSTPARTUM COMPLICATION 674.82 674.84 OTHER COMPLICATIONS OF PUERPERIUM 710.0 SYSTEMIC LUPUS ERYTHEMATOSUS 745.0 COMMON TRUNCUS 745.10 - 745.12 COMPLETE TRANSPOSITION OF GREAT VESSELS - CORRECTED TRANSPOSITION OF GREAT VESSELS 745.19 OTHER TRANSPOSITION OF GREAT VESSELS 745.2 - 745.5 TETRALOGY OF FALLOT - OSTIUM SECUNDUM TYPE ATRIAL SEPTAL DEFECT 745.60 - 745.61 ENDOCARDIAL CUSHION DEFECT UNSPECIFIED TYPE - OSTIUM PRIMUM DEFECT 745.69 OTHER ENDOCARDIAL CUSHION DEFECTS 745.7 - 745.9 COR BILOCULARE - UNSPECIFIED DEFECT OF SEPTAL CLOSURE 746.00 - 746.02 746.09 CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED - STENOSIS OF PULMONARY VALVE CONGENITAL OTHER CONGENITAL ANOMALIES OF PULMONARY VALVE 746.1 - 746.7 TRICUSPID ATRESIA AND STENOSIS CONGENITAL - HYPOPLASTIC LEFT HEART SYNDROME 746.81 - 746.9 SUBAORTIC STENOSIS CONGENITAL - UNSPECIFIED CONGENITAL ANOMALY OF HEART 747.0 PATENT DUCTUS ARTERIOSUS 747.10 - 747.11 COARCTATION OF AORTA (PREDUCTAL) (POSTDUCTAL) - INTERRUPTION OF AORTIC ARCH 747.20 - 747.22 CONGENITAL ANOMALY OF AORTA UNSPECIFIED - CONGENITAL ATRESIA AND STENOSIS OF AORTA 747.29 OTHER CONGENITAL ANOMALIES OF AORTA 747.3 CONGENITAL ANOMALIES OF PULMONARY ARTERY 747.40 - 747.42 747.49 CONGENITAL ANOMALY OF GREAT VEINS UNSPECIFIED - PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION OTHER ANOMALIES OF GREAT VEINS 759.3 SITUS INVERSUS 759.82 MARFAN SYNDROME 780.01 - 780.03 COMA - PERSISTENT VEGETATIVE STATE 780.09 ALTERATION OF CONSCIOUSNESS OTHER 780.2 SYNCOPE AND COLLAPSE 780.60 - 780.61 FEVER, UNSPECIFIED - FEVER PRESENTING WITH CONDITIONS CLASSIFIED ELSEWHERE 782.3 EDEMA 782.5 CYANOSIS LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes 784.3 APHASIA 785.1 PALPITATIONS 785.2 UNDIAGNOSED CARDIAC MURMURS 785.3 OTHER ABNORMAL HEART SOUNDS 785.50 SHOCK UNSPECIFIED 785.51 CARDIOGENIC SHOCK 785.52 SEPTIC SHOCK 785.59 OTHER SHOCK WITHOUT TRAUMA 786.05 SHORTNESS OF BREATH 786.09 RESPIRATORY ABNORMALITY OTHER 786.50 UNSPECIFIED CHEST PAIN 786.51 PRECORDIAL PAIN 786.59 OTHER CHEST PAIN 790.7 BACTEREMIA 794.31 NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM (ECG) (EKG) 799.01 ASPHYXIA 799.02 HYPOXEMIA 807.4 FLAIL CHEST 861.01 - 861.03 901.0 CONTUSION OF HEART WITHOUT OPEN WOUND INTO THORAX - LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS WITHOUT OPEN WOUND INTO THORAX UNSPECIFIED INJURY OF HEART WITH OPEN WOUND INTO THORAX - LACERATION OF HEART WITH PENETRATION OF HEART CHAMBERS AND OPEN WOUND INTO THORAX INJURY TO THORACIC AORTA 901.2 INJURY TO SUPERIOR VENA CAVA 901.41 INJURY TO PULMONARY ARTERY 901.42 INJURY TO PULMONARY VEIN 958.0 AIR EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA 958.1 FAT EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA 958.4 TRAUMATIC SHOCK 960.7 POISONING BY ANTINEOPLASTIC ANTIBIOTICS 962.0 POISONING BY ADRENAL CORTICAL STEROIDS 963.1 POISONING BY ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE DRUGS 861.10 - 861.13 965.09 POISONING BY OTHER OPIATES AND RELATED NARCOTICS 972.0 POISONING BY CARDIAC RHYTHM REGULATORS 972.1 POISONING BY CARDIOTONIC GLYCOSIDES AND DRUGS OF SIMILAR ACTION 980.3 TOXIC EFFECT OF FUSEL OIL 986 TOXIC EFFECT OF CARBON MONOXIDE 990 EFFECTS OF RADIATION UNSPECIFIED 994.0 EFFECTS OF LIGHTNING 994.8 ELECTROCUTION AND NONFATAL EFFECTS OF ELECTRIC CURRENT 995.1 ANGIONEUROTIC EDEMA NOT ELSEWHERE CLASSIFIED 995.20 UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE 995.22 UNSPECIFIED ADVERSE EFFECT OF ANESTHESIA 995.29 UNSPECIFIED ADVERSE EFFECT OF OTHER DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE 996.01 MECHANICAL COMPLICATION DUE TO CARDIAC PACEMAKER (ELECTRODE) 996.02 MECHANICAL COMPLICATION DUE TO HEART VALVE PROSTHESIS 996.04 MECHANICAL COMPLICATION OF AUTOMATIC IMPLANTABLE CARDIAC DEFIBRILLATOR 996.61 INFECTION AND INFLAMMATORY REACTION DUE TO CARDIAC DEVICE IMPLANT AND GRAFT 996.71 OTHER COMPLICATIONS DUE TO HEART VALVE PROSTHESIS 996.83 COMPLICATIONS OF TRANSPLANTED HEART 997.1 CARDIAC COMPLICATIONS NOT ELSEWHERE CLASSIFIED 998.0 POSTOPERATIVE SHOCK NOT ELSEWHERE CLASSIFIED 998.51 - 998.59 INFECTED POSTOPERATIVE SEROMA - OTHER POSTOPERATIVE INFECTION LCD L27536 - Transthoracic Echocardiography (TTE) Description ICD 9 Codes 999.31 INFECTION DUET CENTRAL VENOUS CATHETER 999.39 INFECTION FOLLOWING OTHER INFUSION, INJECTION, TRANSFUSION, OR VACCINATION 999.4 ANAPHYLACTIC SHOCK DUE TO SERUM NOT ELSEWHERE CLASSIFIED V12.53 PERSONAL HISTORY OF SUDDEN CARDIAC ARREST V12.54 V42.1 PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS HEART REPLACED BY TRANSPLANT V42.2 HEART VALVE REPLACED BY TRANSPLANT V43.3 HEART VALVE REPLACED BY OTHER MEANS V58.11 ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY V58.44 AFTERCARE FOLLOWING ORGAN TRANSPLANT V58.64 LONG-TERM (CURRENT) USE OF NONSTEROIDAL ANTI-INFLAMMATORIES V58.65 LONG-TERM (CURRENT) USE OF STEROIDS V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS V59.8 DONORS OF OTHER SPECIFIED ORGAN OR TISSUE V67.51 V72.83 FOLLOW-UP EXAMINATION FOLLOWING COMPLETED TREATMENT WITH HIGH-RISK MEDICATION NOT ELSEWHERE CLASSIFIED OTHER SPECIFIED PRE-OPERATIVE EXAMINATION V81.2 SCREENING FOR OTHER AND UNSPECIFIED CARDIOVASCULAR CONDITIONS Vitamin B12 Assay Description ICD 9 Codes 82607 CYANOCOBALAMIN (VITAMIN B-12) ICD-9 Codes that Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. 040.2 WHIPPLE'S DISEASE 123.4 DIPHYLLOBOTHRIASIS INTESTINAL 151.0 - 151.9 MALIGNANT NEOPLASM OF CARDIA - MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE 152.0 - 152.9 MALIGNANT NEOPLASM OF DUODENUM - MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED SITE MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT NEOPLASM OF PANCREAS PART UNSPECIFIED SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE INCLUDING DUODENUM 157.0 - 157.9 197.4 197.8 SECONDARY MALIGNANT NEOPLASM OF OTHER DIGESTIVE ORGANS AND SPLEEN 261 NUTRITIONAL MARASMUS 262 OTHER SEVERE PROTEIN-CALORIE MALNUTRITION 263.0 MALNUTRITION OF MODERATE DEGREE 263.2 ARRESTED DEVELOPMENT FOLLOWING PROTEIN-CALORIE MALNUTRITION 263.8 - 263.9 OTHER PROTEIN-CALORIE MALNUTRITION - UNSPECIFIED PROTEIN-CALORIE MALNUTRITION 266.2 OTHER B-COMPLEX DEFICIENCIES 270.4 DISTURBANCES OF SULPHUR-BEARING AMINO-ACID METABOLISM 281.0 - 281.3 281.9 PERNICIOUS ANEMIA - OTHER SPECIFIED MEGALOBLASTIC ANEMIAS NOT ELSEWHERE CLASSIFIED UNSPECIFIED DEFICIENCY ANEMIA 284.1 PANCYTOPENIA 285.21 ANEMIA IN CHRONIC KIDNEY DISEASE 285.9 ANEMIA UNSPECIFIED 290.0 SENILE DEMENTIA UNCOMPLICATED 290.10 PRESENILE DEMENTIA UNCOMPLICATED 290.41 VASCULAR DEMENTIA, WITH DELIRIUM 290.42 VASCULAR DEMENTIA, WITH DELUSIONS 290.43 VASCULAR DEMENTIA, WITH DEPRESSED MOOD 291.1 ALCOHOL-INDUCED PERSISTING AMNESTIC DISORDER 291.2 ALCOHOL-INDUCED PERSISTING DEMENTIA 293.0 DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE 294.10 DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITHOUT BEHAVIORAL DISTURBANCE 294.11 DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITH BEHAVIORAL DISTURBANCE 294.8 OTHER PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE 303.91 OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE CONTINUOUS DRINKING BEHAVIOR 331.7 CEREBRAL DEGENERATION IN DISEASES CLASSIFIED ELSEWHERE 331.83 MILD COGNITIVE IMPAIRMENT, SO STATED 334.4 CEREBELLAR ATAXIA IN DISEASES CLASSIFIED ELSEWHERE 354.8 - 354.9 OTHER MONONEURITIS OF UPPER LIMB - MONONEURITIS OF UPPER LIMB UNSPECIFIED 355.8 - 355.9 MONONEURITIS OF LOWER LIMB UNSPECIFIED - MONONEURITIS OF UNSPECIFIED SITE 356.4 IDIOPATHIC PROGRESSIVE POLYNEUROPATHY 356.9 UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY 377.33 NUTRITIONAL OPTIC NEUROPATHY 377.34 TOXIC OPTIC NEUROPATHY 529.0 GLOSSITIS 529.4 ATROPHY OF TONGUE PAPILLAE 529.6 GLOSSODYNIA Vitamin B12 Assay Description ICD 9 Codes 535.10 - 535.11 ATROPHIC GASTRITIS (WITHOUT HEMORRHAGE) - ATROPHIC GASTRITIS WITH HEMORRHAGE 536.0 ACHLORHYDRIA 555.0 - 555.9 REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL ENTERITIS OF UNSPECIFIED SITE 564.2 POSTGASTRIC SURGERY SYNDROMES 577.1 CHRONIC PANCREATITIS 579.0 - 579.9 CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION 751.1 CONGENITAL ATRESIA AND STENOSIS OF SMALL INTESTINE 780.93 MEMORY LOSS 780.97 ALTERED MENTAL STATUS 781.2 ABNORMALITY OF GAIT 781.3 LACK OF COORDINATION 782.0 DISTURBANCE OF SKIN SENSATION V10.00 V10.04 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT PERSONAL HISTORY OF MALIGNANT NEOPLASM OF STOMACH V10.09 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT V12.1 PERSONAL HISTORY OF NUTRITIONAL DEFICIENCY V44.1 GASTROSTOMY STATUS V44.2 ILEOSTOMY STATUS V44.4 STATUS OF OTHER ARTIFICIAL OPENING OF GASTROINTESTINAL TRACT V45.3 POSTSURGICAL INTESTINAL BYPASS OR ANASTOMOSIS STATUS V45.72 ACQUIRED ABSENCE OF INTESTINE (LARGE) (SMALL) V45.75 ACQUIRED ABSENCE OF ORGAN STOMACH V45.86 BARIATRIC SURGERY STATUS V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS Diagnoses that Support Medical Necessity Conditions that are listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy. ICD-9 Codes that DO NOT Support Medical Necessity All those not listed under the "ICD-9 Codes that Support Medical Necessity" section of this policy. ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation Diagnoses that DO NOT Support Medical Necessity Conditions that are not listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy. Vitamin D Assay Description ICD 9 Codes 82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED 82652 DIHYDROTESTOSTERONE (DHT) 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED ICD-9 Codes that Support Medical Necessity It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. The following ICD-9-CM codes support the medical necessity of CPT code 82306. 010.00 - 018.96 135 PRIMARY TUBERCULOUS COMPLEX UNSPECIFIED EXAMINATION - UNSPECIFIED MILIARY TUBERCULOSIS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS SARCOIDOSIS 268.0 RICKETS ACTIVE 268.2 OSTEOMALACIA UNSPECIFIED 268.9 UNSPECIFIED VITAMIN D DEFICIENCY 275.3 DISORDERS OF PHOSPHORUS METABOLISM 275.41 HYPOCALCEMIA 275.42 HYPERCALCEMIA 278.8 OTHER HYPERALIMENTATION 359.5 MYOPATHY IN ENDOCRINE DISEASES CLASSIFIED ELSEWHERE 555.0 - 555.9 REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL ENTERITIS OF UNSPECIFIED SITE 556.0 - 556.9 ULCERATIVE (CHRONIC) ENTEROCOLITIS - ULCERATIVE COLITIS UNSPECIFIED 571.2 ALCOHOLIC CIRRHOSIS OF LIVER 571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL 571.6 BILIARY CIRRHOSIS 576.8 OTHER SPECIFIED DISORDERS OF BILIARY TRACT 579.0 - 579.9 CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION 585.3 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE) 585.4 CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE) 585.5 CHRONIC KIDNEY DISEASE, STAGE V 585.6 END STAGE RENAL DISEASE 696.1 OTHER PSORIASIS AND SIMILAR DISORDERS 710 SYSTEMIC LUPUS ERYTHEMATOSUS 710.3 DERMATOMYOSITIS 729.1 MYALGIA AND MYOSITIS UNSPECIFIED 733.00 - 733.09 OSTEOPOROSIS UNSPECIFIED - OTHER OSTEOPOROSIS 733.9 DISORDER OF BONE AND CARTILAGE UNSPECIFIED 756.51 OSTEOGENESIS IMPERFECTA 756.52 OSTEOPETROSIS V58.65* LONG-TERM (CURRENT) USE OF STEROIDS V58.69* LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS *Use V58.65 with 268.2, to describe current long term use of glucocorticoids and V58.69 with 268.2 to describe long term use of anticonvulsants and other medication known to lower Vitamin D levels. The following ICD-9-CM codes support the medical necessity of CPT code 82652 010.00 - 018.96 PRIMARY TUBERCULOUS COMPLEX UNSPECIFIED EXAMINATION - UNSPECIFIED MILIARY TUBERCULOSIS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS) 135 SARCOIDOSIS 268.0 RICKETS ACTIVE 278.8 OTHER HYPERALIMENTATION 585.3 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE) 585.4 CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE) 585.5 CHRONIC KIDNEY DISEASE, STAGE V 585.6 END STAGE RENAL DISEASE 756.51 OSTEOGENESIS IMPERFECTA 756.52 OSTEOPETROSIS Diagnoses that Support Medical Necessity Conditions that are listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy. ICD-9 Codes that DO NOT Support Medical Necessity All those not listed under the “ICD-9 Codes that Support Medical Necessity” section of this policy. ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation Diagnoses that DO NOT Support Medical Necessity Conditions that are not listed in the “ICD-9 Codes that Support Medical Necessity" section of this policy.